Tissue reaction to Endométhasone sealer in root

J Appl Oral Sci. 511

ABSTRACT

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Tissue reaction to Endométhasone sealer in root ��

Patrícia SUZUKI1, Valdir de SOUZA2, Roberto HOLLAND2, João Eduardo GOMES-FILHO3, Sueli Satomi MURATA4, Eloi DEZAN JUNIOR3, Thiago Rodrigues dos PASSOS1

1- DDS, MSc Postgraduate Program in Endodontics, Dental School, University of Marília (UNIMAR), Marília, SP, Brazil.2- DDS, MSc, PhD, Titular Professor, Department of Endodontics, Araçatuba Dental School, São Paulo State University, Araçatuba, SP, Brazil; Postgraduate Program in Endodontics, Dental School, University of Marília (UNIMAR), Marília, SP, Brazil.3- DDS, MSc, PhD, Associate Professor, Department of Endodontics, Araçatuba Dental School, São Paulo State University, Araçatuba, SP, Brazil.4- DDS, MSc, PhD, Postdoctoral student, Department of Endodontics, Araçatuba Dental School, São Paulo State University, Araçatuba, SP, Brazil.

Corresponding address: Dr. João Eduardo Gomes-Filho - Faculdade de Odontologia de Araçatuba - UNESP - Departamento de Odontologia Restauradora - Endodontia - R. José Bonifácio, 1193 - Araçatuba - São Paulo - Brazil - Phone: (0055) 18 36363252 - Fax: (0055) 18 36363279 - e-mail: [email protected]

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Objective: This study evaluated the response of periapical tissues to the endodontic ��

�� !�� "�� #��$$�%&�� #��'$�%&�� "��#��$�%&�� beyond the apical foramen by the lateral condensation of gutta-percha and Endométhasone, originating 2 experimental groups: G1: Endométhasone/short of the apical foramen; (��)�� *��+� ��.0�� +�� 345��6 ��5�6 ��7��8�� !�� the apical foramen of the main root canal and apical opening of accessory canals, apical �� "��9�� "�� *�� #�� '��<"�'�� <�� =�� #��Wilcoxon nonparametric tests (p=0.05). Results: Comparing the 2 groups, the best result 3�F0�0$8�� 9�� H��I��

Key words: Root canal therapy. Biocompatibility test. Endométhasone.

INTRODUCTION

The apical limit of obturation and the root canal �� 9�� endodontic treatment. It has been observed that �� does not overextend beyond the apical foramen. Seltzer, et al.22 (1963) reported clinical success in P0�QU��+� �!�� "�VQ�VU�� VP��U�� X�� #"� ��

al.26 (1983) analyzed 1,007 endodontically treated teeth over a 20-year period and found a success ��VP�P$U"�� +��+� ��specimens had an approximately 4-fold greater �� (� ��Loianno8 (1990) evaluated endodontically treated teeth 8 years after root canal therapy and found �� 3'� �� !8�� "��+� ��3]��

2011;19(5):511-6


apex) delayed or prevented periodontal healing. The �� have been corroborated by the results of some histomorphological investigations10,11,16,20,23.

In addition to the apical limit of obturation, histological evidence has demonstrated that the type of root canal sealer also has an important role in the treatment outcome11,12,17,25��^�� +� �� important structures, such as nerves, blood vessels, or sinus space, the consequences can be severe. Filling materials might act as a foreign body causing mechanical or chemical irritations of periradicular ��"�� 5,18,21,27.

The most frequently used root canal filling �� &�� Their presence in periradicular tissue, as a foreign body, causes connective tissue responses7. Sealers, �� "� � �� phagocytosed by macrophages7. The nature and the degree of tissue reaction are related to the type and amount of sealer, the location of the extrusion, and the condition of the periodontal tissues. If the sealer is extruded in the mandibular canal space, it can cause problems that vary from ��9�� +� �� !��damage5,18,21,27. Clinical symptoms are disabling sensory disturbances such as pain, paresthesia, and anesthesia5,27��`�� "��+� ��material is in the area of soft tissues, the result can be infection or local irritation5,14.

�!�� +��and paraformaldehyde are the main materials causing neurotoxic reactions2,3,13,15,18,24. Brodin, et al.3 (1982) reported that Endométhasone can irreversibly inhibit the conduction of the action potential in the rat phrenic nerve. Serper, et al.24 (1998) found that the inhibitory effect of Endométhasone on isolated rat sciatic nerves is reversible but is more pronounced than the effect of Sealapex or Calciobiotic root canal sealers and ��'0U&�0U� ��+� �� +��

Radastina, et al.19 (1989), observed a strong ��+�� synthetic apparatus of fibroblast development �� "��"��to correlate the toxicity of Endométhasone to the presence of hydrocortisone. On the other hand, Orstavick and Mijör15�3'.VV8�� +��!��to Endométhasone.

Considering that overfillings are relatively � �7�� histomorphological investigations have investigated the reaction of periapical tissues to Endométhasone, this study evaluated the biocompatibility of this �� apical foramen.

MATERIAL AND METHODS

�� !�� premolars and maxillary incisors from 2 adult �� !��'�� +��and approved by the Research Ethics Committee of ��{��+� �� |��"�6 �#��"��the ethical guidelines for animal experimentation.

�� #�� intramuscular injection of a combination of xylazine (Coopazine®; Coopers do Brasil Ltda, São }��"� X}"� 6 �#��~� 0�0$� �I)*� �� 8� ��tiletamine hydrochloride:zolazepam hydrochloride 3��®-50; Virbac do Brasil, Indústria e Comércio I��"�X��}��"�X}"�6 �#��~�0��I)*��8�

�� rubber cup/pumice prophylaxis and rubber dam ��"� �� polyvinylpyrrolidone-iodine solution (Asteriodine-Aster, Sorocaba, SP, Brazil) and the access cavities �� '0.0�� bur (KG Sorensen, Barueri, SP, Brazil). The pulp ��!�� #��'$�%&��3�� ^�� "�6��"�X��#� ��8"�� *�� #��$$�%&�� &�� 7�� "�� #��'$�%&��3�� ^�� 8�� #�� $�%&�� "�� sterile paper points and immediately obturated by lateral condensation of gutta-percha cones and Endométhasone (Septodont, Saint-Maur-des-Fossés, France).

�� groups of 10 specimens each, according to the sealer and the apical limit of obturation: G1: Endométhasone /short of the apical foramen; G2: Endométhasone /beyond the apical foramen. For �� "�� *�� &�� "�� !�� *�� 3�� ^�� 8��&�� of accessory gutta-percha points and active lateral �� 3�� ^�� 8��6�� *�� +�� 7�� homogeneity and apical extension. Excess material �� +�� +�� +� ��&��

��!��"��#$�%��&��%��'�� *��%��'��#��

2011;19(5):511-6


Figure 1- (A) Endométhasone/short of the apical foramen. Deposition of newly formed cementum on the main root canal �� !""#��$��%��&�� #�'��*��+��<""#��%��&=�� #�>=��+��?CH��!""#��C��%��&=�� #�?��*��K��+�� L""#

�� +�� 3��̂ ^�IH~�GC Corporation, Tokyo, Japan) and silver amalgam (SS White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil).

�� *��+� ��90 days after treatment. The maxillas and mandibles �� &�� +��"��!�� '0U� �� "� �� 'PU��=�� +�� *�� Q&��&��*�� "��!��345�8��6 ��6 ��7��"�and examined under light microscopy by a skilled �!�� !��closure of the apical foramen of the main root canal and apical opening of accessory canals, apical �� "��9�� "�� *��organization of the apical periodontal ligament and 3��'8�� '��<"�'�� <�� "�� +��established criteria10�� statistically analyzed by Wilcoxon nonparametric

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RESULTS

Group 1: (Endométhasone/short of the apical foramen; n=10). The apical foramen of the main ��'��}� �� +��in 1 specimen and in the other 8 specimens, �� H�� of the apical opening of most accessory canals in the apical delta occurred in 8 specimens and in 2 �� cemental resorption in all specimens. Bacteria and ��9�� +��"�� 9�� specimens, being severe in 2 specimens, moderate in 1 and mild in 7 specimens (Figure 1A). Discrete � �� +��3�� '68��}=I��*��.$�� +� �� }=I� �� #�� $��&� ��#��)<��portion in the other 5 specimens.

Group 2 (Endométhasone/beyond the apical

SUZUKI P, SOUZA V, HOLLAND R, GOMES-FILHO JE, MURATA SS, DEZAN E Jr., PASSOS TR

2011;19(5):511-6


Histomorphological parameters Scores GroupsEndométhasone(n=20)

G1 (n=10)short

G2 (n=10)beyond

Closure of the apical foramen of the main root canal

1=complete closure -- --

2=partial closure 1 --

3=deposition on lateral walls 8 a --- b

4=no closure 1 10

Closure of the apical opening of the accessory canals

1=all accessory canals -- --

2=most accessory canals 8 3

3=few accessory canals 2 a 7 a

4=no accessory canals -- --

Apical cementum resorptions 1=absent or totally repaired 10 5

2=partially repaired -- --

3=non-repaired -- a 5 b

4=active resorption areas -- --

'��WW 1=absent -- --

2=mild: <10 cells 7 1

3=moderate: 11 to 25 cells 1 a -- b

<Y��*��Z�[L\�� 2 9

Presence of giant cells 1=absent 8 2

2=discrete: <3 cells 2 6

3=moderate: 4 to 6 cells -- a 2 b

<Y'��Z�[]�� -- --

Apical PDL thickness*** !`L""�q� 2 1

LYL"!��{""�q� 3 1

{Y{"!��<""�q� 1 a -- a

<[<""�q� 4 8

Apical PDL organization*** 1=well-organized PDL in all 4 parts of the apical third

5 1

2=well-organized PDL in 3 parts 5 a 7 a

3=well-organized PDL in 1 or 2 parts -- 2

4=totally disorganized apical PDL -- --

Group X group comparison a b

Table 1- Distribution of specimens according to the histomorphological parameters and scores

WC��\}��~��K��#�WW'��*��+��K<""��#�WWW�� *��<� ��#�?CHY ��ligament

foramen; n=10). The apical foramen of the main ��3��'H8��^��specimens, the apical opening of most accessory �� "�� P��

completely the areas of cemental resorption in 5 ��"�� $�� 6�� 9�� +�� 4��+� "��+� ��&��&�� '�and 9 specimens, respectively (Figure 1C). Giant

��!��"��#$�%��&��%��'�� *��%��'��#��

2011;19(5):511-6


�� "� �� +�� Q�specimens, respectively (Figure 1D). The apical }=I��*��$$0��+� ��}=I�� #��'��organized in 3/4 of the apical portion in 7 specimens and in 1/2 of the apical portion in the other 2 specimens.

Distribution of specimens according to the histomorphological parameters and scores is presented in Table 1.

Statistical Analysis

�� #��"�� than those extended beyond the apex (p=0.05) (Table 1).

DISCUSSION

In this study, none of the obturation limits proposed for the endodontic treatment using �� maintaining the normality of the periapical tissues �� +�� +�� 3.0��8�� 9�� regardless of the apical limit of obturation, being �� +� �� +� �!�� +� ��"�� +��histomorphological investigations10,11,16,20,23. It is ��9�� +��+� �� !� �� !� ��to the periapical region6,9.

In the root canals obturated beyond the apex, �� of connective tissue into the canal in all specimens �+� �� +��histopathological and x-ray microanalysis of the subcutaneous tissue response to endodontic sealers found that zinc oxide-eugenol-based materials appeared more resistant to fragment into small-sized particles for macrophage phagocytosis15 as �� +�� &�� tissue28. Therefore, proper attention should be given to the apical limit of root canal obturation during the endodontic treatment because sealer extrusion to the periapical region may be responsible for the increase or persistency of posttreatment residual �� 9��"� �� radiographically4,15.

The findings of this study regarding the biocompatibility of Endométhasone are in agreement �� +��+�� the presence of inflammatory infiltrate in the periapical region of monkey’s teeth 180 days after endodontic treatment1,16. It has been considered �� 9��closure of the main apical foramen and accessory �� cementum represent the ideal repair after root canal obturation10,11. In the present study, the absence of complete closure of the main foramen and the � �� 9�� "� �� !��in the overextended group, demonstrated that Endométhasone did not provide the ideal endodontic ��4��+� "�� +��tissue partially surrounding large fragments of the sealer, as observed in some specimens, suggests that complete encapsulation of the large particles �� "� �� 9��

CONCLUSIONS

Based on the methodology employed and the results of the present study, it may be concluded �� space apically is important to determine the best � ��is sealer.

REFERENCES

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Tissue reaction to Endométhasone sealer in root